Cody Cunningham

Welcome to our new fellows!!! SO excited for the start of a new year!!!

7 years of training down, 3(?) to go

Medicine resident wins award

Probable extinction of influenza B/Yamagata and its public health implications: a systematic literature review and assessment of global surveillance databases Early after the start of the COVID-19 pandemic, the detection of influenza B/Yamagata cases decreased globally. Given the potential public health implications of this decline, in this Review, we syste...

Also there are now only 3 strains in the vaccine 2/2: www.thelancet.com/journals/lan...

We (Arizona) peaked at 131% above 5 year average a few weeks ago, thankfully we have continued to downtrend

Barcoded SARS-CoV-2 viruses define the impact of duration and route of exposure on the transmission bottleneck in a hamster model Barcoded SARS-CoV-2 enables precise, quantitative studies of transmission.

Great paper overall, look forward to seeing how the authors move this work forward #IDSky www.science.org/doi/10.1126/...

During aerosol transmission, virus appeared to be sourced from the upper airway (nasal turbinates) but not the trachea or lungs

The number of unique barcodes transferred depended on route of infection with direct contact > aerosol > fomite

During productive aerosol transmission, between 13 - 42 unique viruses were transferred. Upper and lower airways had unique signatures suggesting independent seeding by different virus particles.

The authors generated >200 unique (barcoded) viruses that were fitness neutral in vitro and in vivo

Barcoded SARS-CoV-2 viruses define the impact of duration and route of exposure on the transmission bottleneck in a hamster model Barcoded SARS-CoV-2 enables precise, quantitative studies of transmission.

Really elegant paper using barcoded SARS-CoV-2 to explore virus transmission in a small animal model. Some highlights: #IDSkyhttps://www.science.org/doi/10.1126/sciadv.ads2927

New paper describing different routes of H5N1 infection in a non-human primate model #IDsky www.nature.com/articles/s41...

Outcomes of Coccidioides Seropositive Solid Organ... : Transplantation by enzyme immunoassay (EIA-IgM-only), although this result may be falsely positive. Methods. We conducted a retrospective study at a large-volume transplant center in an endemic coccidioidomycosis ...

Excited to share our research on duration of antifungal ppx for Cocci in SOT!

TLDR; For patients repeatedly pos for EIA-IgM-only w no seroconversion, compatible clinical illness, or rads findings, discontinuing antifungal ppx may be reasonable after 1st posttxp yr

journals.lww.com/transplantjo...

Epidemiology and Outcomes of Antibiotic De-escalation in Patients with Suspected Sepsis in US Hospitals Cody A Cunningham, Dan Ilges; Epidemiology and Outcomes of Antibiotic De-escalation in Patients with Suspected Sepsis in US Hospitals, Clinical Infectious

New correspondence in CID from myself and Dan Ilges discussing important recent work on antibiotic deescalation in patients with sepsis #IDsky
academic.oup.com/cid/advance-...

Single-dose suraxavir marboxil for acute uncomplicated influenza in adults and adolescents: a multicenter, randomized, double-blind, placebo-controlled phase 3 trial - Nature Medicine Suraxavir marboxil, an antiviral drug designed to inhibit the polymerase acidic protein of influenza, alleviates symptoms in individuals with influenza faster than placebo in a phase 3 trial conducted...

Interesting data on suraxavir-marboxil for uncomplicated influenza. Hopefully the there is less treatment emergent resistance than the other PA endonuclease inhibitor on the market #IDsky
www.nature.com/articles/s41...

www.nature.com/articles/s41...

Very interesting pair of papers out this week redefining T cell responses to acute vs chronic viral infections #IDSky www.nature.com/articles/s41...

3. The test only detects Legionella pneumophilia serogroup 1, and serogroup
composition varies geographically
4 . Peak positivity occurs 5 – 10 days into illnes

Bottom line (1/2):
1. Currently, the ATS/IDSA recommend obtaining Legionella testing only in patients with severe CAP or epidemiologic risk factors (such as association w/ an outbreak or recent travel)
2. The urine test only has modest sensitivity but good specificity

Legionella by both PCR and culture! The patient recovers well after a course of effective
therapy.

Back to the case, given the patient’s immunocompromised state he ultimately undergoes
a bronchoscopy with BAL which shows…

When using the Legionella urine antigen test, it is also critical to know the relative
abundance of L. pneumophila serogroups. For my local area, serogroup 1 (detected by the urine test) makes up less than half of all confirmed Legionella cases.
pubmed.ncbi.nlm.nih.gov/30814318/

A second consideration is the duration of symptoms. One study found that the peak of urine antigen positivity (black bars) occurred 5 – 10 days into illness.
pubmed.ncbi.nlm.nih.gov/14970242/

What's important to remember when interpreting these tests is that they detect only
Legionella pneumophilia serogroup 1. When restricting to this serogroup only, the pooled sensitivity was somewhat improved at 0.86 (95% CI 0.78-0.91)

Diagnostic accuracy of urinary antigen tests for legionellosis: A systematic review and meta-analysis - PubMed The review protocol was prospectively registered with the University Hospital Medical Information Network Clinical Trials Registry (UMIN000041080).

Several SRMAs have addressed this question, the most recent found that the Legionella urine antigen test had a pooled sensitivity of 0.79 (95% CI, 0.71-0.85).
pubmed.ncbi.nlm.nih.gov/34972680/

Negative. Does this test sufficiently rule out Legionella?

Given concomitant PNA and gastrointestinal symptoms (and occupational exposure to cooling systems), Legionella thought to be high on the differential and empiric antimicrobials are chosen to cover for Legionella. However, the urine antigen test is…

How good (or bad) is the Legionella urine antigen test?

A middle-aged SOT patient presents to the ED with fever, cough, and diarrhea of 2 days duration. T = 39.4 C, rest of vitals stable. Labs show neutrophilic leukocytosis and mild hyponatremia. CT of the chest shows a LLL consolidation. #IDSky

Im not sure how much baloxavir marboxil added to this case (if we can extrapolate from endemic IAV), but it certainly has the coolest MOA in ID

Incredibly THRILLED to introduce the incoming WashU Infectious Diseases Fellowship Class of 2025. The future is SO bright!